Summary:

Zol Szabo, is public health doctor for the Hamilton Ontario region. He is also a single parent to nine year-old, Max, because his wife could not deal with Max’s mild physical disability. He is dating Colleen an attractive woman detective whom he met in the previous novel. The story opens with Zol’s angst over his son’s expensive misuse of a cell phone that he’d been given for safety reasons.

Soon he and his team are investigating cases of diarrhea in a seniors’ residence.  The diagnosis is difficult—but the doctors are confident they know what it is; however, the recommended treatments prove ineffective. Gradually they begin to suspect that the drugs are not working because they might be fake. Even worse, they notice that the people infected are all taking the same arthritis medicine—could that drug be the source of the infection?

In the background an unbending hospital administration and a hostile boss make the situation even worse.

A team of elderly friends who reside in the senior’s home collaborate to help solve the mystery. And of course the son’s cell phone is crucial to the dramatic conclusion.

 

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In this tale, told by an aging Silvio, Jean the miller dies mysteriously in the river at his mill leaving his young wife, Colette, and a little boy. Was it suicide or murder – and why?  Colette is the daughter of Helene Coudray, a woman Silvio once loved and still admires deeply, although she married François. They remain good friends.

Silvio is also friendly with Brigitte. She is known to all as the adopted daughter of Helene’s late unmarried sister, Cecile.  Brigitte married a much older landowner who dies, leaving her well off, and free to marry handsome young Marc Ohnet.  But news of the engagement devastates Colette. Suddenly it is clear that her child was Marc’s– and that it was Marc who killed Jean, possibly by accident. Colette’s angry father wants to press charges against Marc for killing his son-in-law. But Brigitte reveals that she is the biological daughter of Helene and Silvio; Marc is to become another son-in-law.

The apparently worthy Helene has deceived both her husband and her old lover, Silvio, by concealing Brigitte’s existence and identity. She also abused the goodwill of her sister who cared for her child. 

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During World War II, a man is found beaten and unconscious in the streets of Trieste and brought to a German hospital ship. The Finnish-born doctor serving the German naval forces recognizes the name on his uniform as that of a vessal originating in Helsinki, the “Sampo Karjalainen." When the man wakes up, he has total amnesia; his memory loss has extended to language. In a crazy gesture of compassion, the doctor arranges for the man to be conveyed across war-torn Europe and home to Helsinki to be tended by a specialist. The doctor hopes that exposure to his homeland, its culture, and especially its language, will help the recovery of the man now called Sampo. They never see each other again.

Isolated and confused, Sampo, is given a bed in an empty visitors' ward of the hospital. The much awaited specialist never appears and Sampo never understands why. His closest friend is a tippling priest who teaches him Finnish through a reading of the Kalevala legends, libated with shots of Kosenkorva. He befriends some Russians who are housed briefly in his ward and he contemplates the hostilities between the nations. He wanders the city of Helsinki looking for triggers that may hand him back his identity – his past, a narrative. One of the nurses takes an interest in his case, shows him a special memory tree in a Helsinki park – and accepts his rejection of her affection with good grace. She is transferred to another place, but writes to him. He is unable to respond. She is angry.

In desperation Sampo joins the Finnish army and leaves for the eastern front. An epilogue tracks his demise and the doctor’s later discovery of his massive error. 

 

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This is a huge and wonderful book about cancer, the collection of diseases that sickens people all over the globe and kills many of them. An epigraph to the book states, “A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer,” but the book also describes medical advances that now heal, prevent, or palliate most forms of cancer.

Mukherjee, a cancer physician and researcher, has several strong themes. He sees cancer as an affliction with a long history, a story worthy of a biography; indeed recent discoveries show it to be rooted in our genes (although external factors such as viruses, asbestos, and tobacco smoke can cause genetic disruption). The story of cancer implies a surrounding triangle, the stories of sick people, treating physicians, and biological researchers, all of which Mukherjee artfully weaves across 472 pages. Cancer has Rohrschach blot qualities: depending on time, place, and role in life, humans have perceived different attributes of cancer. As the book ends, however, there is a coalescence of scientific understanding that is satisfying—although there is certainly more to be learned and we are all still vulnerable to genetic errors and, of course, we are intractably mortal.

Another strand is the nature of stories themselves, their twists and turns, presumed early solutions, and personal and social values embedded in them. Mukherjee threads throughout the book the case of a contemporary kindergarten teacher, Carla Reed, who has a leukemia. He bookends his text with ancient Persian Queen Atossa with (presumably) breast cancer. Reed, healed by the end of the book, was Mukherjee’s patient; Atossa was described by Herodotus: both suffered emotional turmoil because of their disease.  Mukherjee understands the affective dimensions of disease for patients and caregivers alike; literature represents these in various ways, and he quotes in his chapter epigraphs and in his prose many writers who describe human experience deeply: Aleksandr Solzhenitsyn, Susan Sontag, Charles Dickens, Thomas Mann, William Carlos Williams, Carlo Levi, and Italo Calvino, to name a few.

The primary story, however, is the interplay of cancer and a large cast of observers, investigators, doctors, scientists, activists, and government officials. Sidney Farber and Mary Lasker dominate the first 100 pages with their two-decade war against cancer. While surgery—historically dramatic and disfiguring—had been a mainstay for treatment of cancer, Farber pursued a biochemical route, which elaborated into chemotherapy, the second major approach of the late 20th century.

Mukherjee also explains ancient views, Hippocrates’, Galen’s humors, Vasealius’ anatomy, Hunter’s stages, Lister’s antisepsis, and Röntgen’s X-rays, which became the third major approach. By 1980, however, the American “War on Cancer” had not been won.

Further advances in cellular biology and genetics would be needed to make targeted molecular therapy possible.  Mukherjee tells this complicated story clearly and engagingly, showing the human investigators to be personable and dogged in their pursuits.  

Another important approach is prevention. The biostatistical work of Doll and Hill, for example, showed the links between tobacco and lung cancer. Screening, such as Pap smears and mammograms, also saved lives, but the basic cellular understanding still eluded investigators.

The final 150 pages explain the search for and discovery of genetic factors, specifically oncogenes. Harold Varmus and J. Michael Bishop were the leaders, winning a Nobel Prize in 1989. Bert Vogelstein, Judah Folkman, Robert Weinberg and Douglas Hanahan took the work further, opening the doors for such drugs as Herceptin, Gleevec, and Avastin. 

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Haunted by his past actions and wartime experiences, the narrator empties his soul to a silent stranger - a woman sitting and drinking with him at a bar in Lisbon. He tells her about his participation in the colonial war between Portugal and Angola in the early 1970's. He admits to the conflict that still rages inside him. Six years earlier, as a physician in his twenties, he was drafted and shipped 6,000 kilometers from home for a slightly more than two year stint as an army doctor. He left behind a pregnant wife.

While in Africa, he witnessed the waging of a crazy war and was called upon to patch up its many casualties. He describes the maiming, inhumanity, and death that he observed. Questions about political power and morality trouble him. In the midst of this horror, he becomes increasingly cynical and skeptical. On his return home, the narrator acknowledges that he has lost part of himself in Africa. He gets divorced, feels hopeless, and is incapable of shrugging off loneliness.

He and the woman leave the bar and go to his apartment where they have a sexual encounter. She has been an adept listener. The narrator's lengthy confession may have been therapeutic for him. But like everything else in this doctor's post-military service life, any solace is brief. The war has polluted him, and he struggles to clean up the mess.

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As the film opens, Gianni (Kim Rossi Stuart) prepares to meet for the first time the child he fathered 15 years earlier. The boy, Paolo (Andrea Rossi), was born with cerebral palsy and is of below average intelligence as well as being physically handicapped. Paolo's 19-year-old mother died when he was born, and Gianni could not bear to see the baby, or to have any subsequent contact with him. Paolo has been raised by his uncle, the dead woman's brother. Now Gianni, who lives in Milan with his wife and baby, prepares to take Paolo to a rehabilitation facility in Germany.

Paolo is trusting and does not question Gianni's long absence from his life. He manages to walk with the help of a cane, and tries to function as independently as he is physically capable of. When Gianni tries to feed him with a fork, Paolo responds by feeding Gianni instead. Many such small gestures that Paolo makes towards Gianni loosen Gianni's reserve, and each begins to respond to the other with affection.

In Germany, neither Gianni nor Paolo understand the language--in this they are equally disadvantaged. Gianni meets Nicole (Charlotte Rampling), mother to a teenage girl whose palsied speech impairment makes her unintelligible to anyone except Nicole. From the way that Gianni interacts with Paolo, Nicole senses that Gianni is Paolo's father, although Gianni at first denies it, claiming he is a friend of the family. When Gianni finally is truthful with Nicole, and worries about how Paolo will survive as an adult, she warns him that suffering is inevitable for the parent of an impaired child.

Gianni is horrified by the intensive physical therapy regimen to which Paolo is subjected in the German rehab facility, and removes the boy from therapy. He decides to bring Paolo home with him, but as they are driving back to Italy, Paolo "acts out" and Gianni realizes to his great sorrow that Paolo wishes to return to his uncle and live as he has for the first 15 years of his life. He has the keys to the house he grew up in and doesn't want to give them up.

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In this autobiographical novel, written while the author was under severe mental strain and as she recovered from psychotic breakdown, Head tracks the protagonist Elizabeth’s struggle to emerge from the oppressive social situation in which she finds herself, and from the nightmares and hallucinations that torment her. Elizabeth, like Bessie Head, was conceived in an out-of-wedlock union between a white woman of social standing, and a black man--a union outlawed by her country of birth, South Africa.

Like the author, Elizabeth leaves South Africa with her young son--but without her husband, from whom she is fleeing--to live in neighboring Botswana, a country that has escaped some of the worst evils of colonial domination. But in rural Botswana she is once again faced with a constricting social system as the African villagers are suspicious of her urban ways and frown upon her individualistic behavior. Further, they bear her ill will on racial grounds because she is light skinned like the "bushmen" who are a despised tribe there.

Elizabeth suffers not only social isolation but intellectual deprivation as well. One of the few people with whom she can converse as an intellectual equal is the American peace corps volunteer, Tom, who acknowledges that "men don’t really discuss the deep metaphysical profundities with women" (24). During the four years in which Elizabeth is plagued by tribal suspiciousness, terrifying dreams, economic hardships, and two hospitalizations for mental breakdown, it is Tom, and her own love for and obligation to her young son that help her to survive this ordeal.

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This novel takes place during the Ice Age at a time when modern humans (Cro-Magnon) have immigrated into northern Europe and begun to interact with the Neanderthal people, who have already been successful inhabitants of Europe for perhaps 100,000 years. Within several thousand years of this fateful encounter, which took place about 35,000 years ago, the Neanderthal people had completely died out. Early mitochondrial DNA evidence indicated that modern humans are unrelated to the Neanderthal--their gene pool simply disappeared--although more recent studies show that perhaps 2 to 3% of our mitochondrial DNA was inherited from the Neanderthals, who prbably died out as a result of modern humans' greater success in competing for food and other resources.

In this scenario modern humanity originated from a version of the Biblical story of Cain and Abel, of brother "killing" brother, except in the paleontological case the younger brother was responsible for the demise of the elder. Bjorn Kurten, an eminent European paleontologist, used this novel to present his ingenious theory to explain what happened.

The story is told from the perspective of Tiger, a young black (Cro-Magnon) man whose father is killed in a raid by men from another band of blacks. Later, he devotes his life to searching for his father's killer. In the process he travels widely and encounters a band of whites (Neanderthal), a seemingly primitive form of humanity known to Tiger's folk as "trolls." The trolls have a high-pitched, bird-like language that Tiger is eventually able to learn, even though it is virtually impossible for whites (trolls) to learn the black language, because they are unable to articulate the broad range of vowel sounds it includes.

The whites are also different in that their bands are equalitarian, with women playing major leadership roles, while black tribes are strictly hierarchical and patriarchal. Tiger travels with the white band and mates with Veyde, one of its prominent members. However, one day the band is decimated by a marauding black tribe led by the warrior, Shelk.

In the story's climax Tiger carries out a scheme to infiltrate the "bad" tribe and kill Shelk, who he believes is his father's murderer. In fact, ther real murderer was Shelk's twin brother, also called Shelk. The two had used the same name to make it appear that "Shelk" could be in two places at once, thus proving he had supernatural powers. We learn that the Shelk twins had mixed black-white parentage. Children of such unions seem god-like in that they are stronger and more attractive and creative than "normal" people of either group. The "good" Shelk finally finds the white father he has been searching for all his life. And, Tiger lives happily ever after with his white mate Veyde, but their children, though strong and resourceful, will inevitably be sterile. 

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This memoir spins out in detail the despair and violence that emerges from a childhood of poverty and parental absence. When Dubus was preadolescent, his writer father of the same name (see Andre Dubus), took up with a student of his, and the parents divorced. Andre's mother became a social worker, working full-time with no support system, exhausted. Although Andre's father lived nearby and paid child support, it was never enough to keep the four children and their mother out of poverty. They moved frequently, always to the rough sections of depressed Massachusetts towns on or near the Merrimack River. The memoir describes vividly the smells of the polluted river; garbage strewn lawns; smoky, raucous bars; afternoons and evenings spent aimlessly watching television and, in adolescence, neighborhood kids and punks doing drugs and sex in Andre's home - before his mother arrived back from work each evening  .

At school, in bars, and around the neighborhood, kids and adults beat each other up - violence was a constant. Andre was slight and fearful but also drawn to watch the frequent fights. He avoided direct involvement when he could, was beaten up when he couldn't, and loathed himself in either case. He felt like a non-person: "There was the non-feeling that I had no body, that I had no name, no past and no future, that I simply was not. I was not here" (78). Finally, after being unable to help his brother during a fight, Andre resolved to build himself up physically--lifting barbells, bench pressing, and eventually taking boxing lessons.

Now when there was the threat of a fight, he plunged in quickly, inflicting damage. He could defend himself and those he cared about. But always there was the need for vigilance and the need - frequently actualized - to explode in rage. Later, he came to realize that being quick to jump into fights was a way "to get out what was inside him. Like pus from a wound, it was how [I] expressed what had to be expressed" (191). Gradually Andre came to think there might be other ways "to express a wound."

In the second part of the memoir, Dubus writes of how that other way evolved into creative writing. Training for physical prowess had imposed some discipline in his life, which meant being able to concentrate in school, do homework, and read. There were stints in and out of college (eventually he graduated from the University of Texas in Austin), making ends meet as a gas station attendant, construction worker, fast food manager, bartender, and later-- halfway house counselor. At the local Massachusetts college he attended for a while, he overheard himself being called a "townie." He navigated at the interface of the old neighborhood where he still lived and the life of the more privileged. He became more self-aware, more interior, and at the same time, more interested in the larger world. Threaded throughout this period is a developing relationship with his father, whose writing he admired and whose approval he craved.

In spite of the author's ambivalence toward his father - "where were you when I needed you?" (333)--one probably cannot overestimate the role that the senior Dubus played as a writer model for his son. Dubus read and admired his father's stories. He saw the discipline required to write, even though Dubus senior's weekends were often spent unwinding in bars (sometimes with the younger Dubus). Andre met his father's academic colleagues, met other writers, met writers who had stable relationships with a spouse.

He even learned that a writer can be a sports fan (Boston Red Sox), and avid sports participant (jogger). One of the most moving chapters in the book describes the first baseball game Dubus ever attended or watched - at age 13 - (with two tickets from his father), to see the Red Sox play the Yankees in Boston. Dubus went with a friend who explained the game to him as it unfolded. Dubus was stunned: "Every time one of them walked up to home plate with his bat, hundreds of men and boys would yell insults at him I couldn't quite make out, just the tone, which I knew well, but it wasn't directed at me or anyone I would have to try to protect, and I felt relieved of everything, part of something far larger than I was, just one of thousands and thousands of people united in wanting the same thing, for those men from our team to beat the men from the other team, and how strange that they did this by playing, that one beat the other by playing a game" (161-162).

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In the eighteenth century, Europe began to take stock of the horrific infant mortality in foundling homes and hospitals. Infant feeding and care became a major preoccupation for charities and philanthropic doctors. Some organized systems of wet nurses in the communities and institutions to provide for motherless children. 

At the same time, syphilis was becoming a serious problem in newborns. The sexually transmitted disease, which swept the continent following the voyages of Columbus, was known to affect babies born to infected mothers. Since the early sixteenth century, doctors had been convinced that mercury was of benefit.

Founded in 1724, the Vaugirard Hospital of Paris was the city’s home for orphans. By 1780 it had made room for mothers with syphilis and their children.  Sometimes the mothers died, or well-off families would abandon their sick children. Healthy wet nurses were engaged to feed these babies.

Eventually, the wet nurses were viewed as a technology—a vehicle--for administering mercury to the babies through their milk. Many of these healthy women fell ill, either from the mercury or by infection from their charges. Nevertheless, the practice continued into the nineteenth century. The wet nurses did not know (or were not told) that the children were infected. The physicians in charge of this experiment also attempted unsuccessfully to vaccinate the wet nurses against syphilis. That experiment also spread the disease.

Remarkably, some wet nurses brought suits against the doctors or the birth families. Occasionally they won damages, and finally the law was changed to offer greater protection.

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